Provider Demographics
NPI:1790535359
Name:OMORODION, OSAYOMWANBO (NP)
Entity Type:Individual
Prefix:
First Name:OSAYOMWANBO
Middle Name:
Last Name:OMORODION
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 CARTA WAY APT 2055
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-6416
Mailing Address - Country:US
Mailing Address - Phone:214-856-9169
Mailing Address - Fax:
Practice Address - Street 1:2340 CARTA WAY APT 2055
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-6416
Practice Address - Country:US
Practice Address - Phone:214-856-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189795163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse